Is Phenobarbital Used Anymore As A Migraine Preventative?

Question

Asked by JeffAsh

Is Phenobarbital Used Anymore As A Migraine Preventative?

I lost my headache specialist last month due to his retirement, and, next week, I'm set to see a neuro he recommended I see. I've been assembling my last few months' diaries (averaging 18 headache days requiring medication) along with my medication history and a few test results. Between the ages of 10 and 14, I had a bout of migraines, and ultimately, I was prescribed and responded positively to phenobarbital. Over the twelve years of my current bout of migraines, I've seen four doctors and have told them my phenobarbital story. To a doctor, they were all fairly dismissive saying there were better, more advanced anticonvulsants (which I don't doubt). From my research, phenobarbital can be fraught with peril with misuse. And I understand it might not work for me now, but am I totally off-base pressing my new doctor to give it a try? I've tried several of the newer anticonvulsants (i.e. Topamax, Depakote, Zonegran, Neurontin, and another one that escapes me. I'm currently taking nortriptyline and atenolol. Clearly, they aren't working that well.

Answer

Hi, Jeff,

I wanted to add something to what Ellen told you. Phenobarbital is a barbiturate, and research has shown that any use of barbiturates increases the risk of episodic Migraine becoming chonric, and it makes it horribly more difficult to get chronic Migraine back to episodic.

If used at all, any medications that are barbiturates or contain a barbiturate should be used only sparingly as rescue medications to be taken when we have a Migraine and our first-line treatments have failed.

So, yes, honestly, you are off-base asking for phenobarbital as a preventive. I don't know how you functioned taking it as a preventive since it's sedating.

Hope this helps a bit,

Teri

Answered by Teri Robert